J Cutan Pathol 2014: 41: 720–723 doi: 10.1111/cup.12361 John Wiley & Sons. Printed in Singapore
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Journal of Cutaneous Pathology
A report of three cases of pediatric proliferative fasciitis Proliferative fasciitis is a rapidly growing myofibroblastic proliferation that more commonly presents in adults as a subcutaneous mass. Cases in children can cause diagnostic difficulty, as histological features often differ from classic proliferative fasciitis. We present three cases of pediatric proliferative fasciitis, in children age 5–7. Case 1 involved the subcutis and resembled conventional proliferative fasciitis. The lesion was focally positive for desmin. Case 2 involved the subcutis and was more cellular with focal sheet-like areas of ganglion-like fibroblasts. Case 3 involved the dermis and subcutis with a diffuse, solid sheet-like pattern of ganglion-like myofibroblasts with numerous mitotic figures (4 per 10 high power fields), necrosis and foci of acute inflammation. This case had a circumscribed pushing border rather than the more common infiltrating border seen in proliferative fasciitis. The cells were positive for desmin but negative for cytokeratin and had retained SMARCB1 expression. Proliferative fasciitis in childhood can have a varied histological appearance that can cause confusion with malignancies. Awareness of these histological pitfalls is critical to avoid potentially serious diagnostic errors.
Gabriela Rosa and Steven D. Billings
Keywords: epithelioid sarcoma, proliferative fasciitis, rhabdomyosarcoma, xanthogranuloma
Steven D. Billings, MD Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue L25, Cleveland, OH 44195, USA Tel: +1 216 444 2826 Fax: +1 216 445 6967 e-mail: [email protected]
Rosa G, Billings SD. A report of three cases of pediatric proliferative fasciitis. J Cutan Pathol 2014; 41: 720–723. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Proliferative fasciitis is a benign myofibroblastic proliferation that typically presents as a rapidly growing subcutaneous mass in adults. In 1987 Lorenc reported a case of proliferative fasciitis in the hand of a 7-year-old girl.1 In 1992, Meis and Enzinger further established this diagnosis in children in a series of 11 pediatric cases, ranging from 2.5 months to 13 years.2 Most lesions in Meis and Enzinger’s series were between 1.5 and 3 cm, however, one patient had an 11 cm arm mass and three patients received chemotherapy for this benign entity, as they were initially misdiagnosed as malignant neoplasms; 6 of 11 cases had an initial diagnosis of rhabdomyosarcoma
720
Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
Accepted for publication May 3, 2014
and 1 case had a working diagnosis of malignant fibrohistiocytic neoplasm. In adults, the lesion is typically poorly circumscribed with a tissue culture-like fibroblastic spindle cell proliferation and admixed ganglion-like myofibroblasts. In adults, necrosis and acute inflammation are uncommon.3 Mitotic figures may be numerous, in both adult and pediatric cases, but are never atypical.4 Cases in children can cause diagnostic difficulty, as histopathological features often differ from classic proliferative fasciitis. Pediatric lesions are often well circumscribed, with a more solid growth pattern and may have acute inflammation and necrosis.3
Pediatric proliferative fasciitis We present three cases of pediatric proliferative fasciitis diagnosed over a 15-year period in a busy tertiary hospital and discuss the histopathological features and differential diagnosis. Materials and methods The institutional files and consultation files were searched for the diagnosis of proliferative fasciitis. For inclusion, the cases had to occur in patients
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Journal of Cutaneous Pathology
A report of three cases of pediatric proliferative fasciitis Proliferative fasciitis is a rapidly growing myofibroblastic proliferation that more commonly presents in adults as a subcutaneous mass. Cases in children can cause diagnostic difficulty, as histological features often differ from classic proliferative fasciitis. We present three cases of pediatric proliferative fasciitis, in children age 5–7. Case 1 involved the subcutis and resembled conventional proliferative fasciitis. The lesion was focally positive for desmin. Case 2 involved the subcutis and was more cellular with focal sheet-like areas of ganglion-like fibroblasts. Case 3 involved the dermis and subcutis with a diffuse, solid sheet-like pattern of ganglion-like myofibroblasts with numerous mitotic figures (4 per 10 high power fields), necrosis and foci of acute inflammation. This case had a circumscribed pushing border rather than the more common infiltrating border seen in proliferative fasciitis. The cells were positive for desmin but negative for cytokeratin and had retained SMARCB1 expression. Proliferative fasciitis in childhood can have a varied histological appearance that can cause confusion with malignancies. Awareness of these histological pitfalls is critical to avoid potentially serious diagnostic errors.
Gabriela Rosa and Steven D. Billings
Keywords: epithelioid sarcoma, proliferative fasciitis, rhabdomyosarcoma, xanthogranuloma
Steven D. Billings, MD Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue L25, Cleveland, OH 44195, USA Tel: +1 216 444 2826 Fax: +1 216 445 6967 e-mail: [email protected]
Rosa G, Billings SD. A report of three cases of pediatric proliferative fasciitis. J Cutan Pathol 2014; 41: 720–723. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Proliferative fasciitis is a benign myofibroblastic proliferation that typically presents as a rapidly growing subcutaneous mass in adults. In 1987 Lorenc reported a case of proliferative fasciitis in the hand of a 7-year-old girl.1 In 1992, Meis and Enzinger further established this diagnosis in children in a series of 11 pediatric cases, ranging from 2.5 months to 13 years.2 Most lesions in Meis and Enzinger’s series were between 1.5 and 3 cm, however, one patient had an 11 cm arm mass and three patients received chemotherapy for this benign entity, as they were initially misdiagnosed as malignant neoplasms; 6 of 11 cases had an initial diagnosis of rhabdomyosarcoma
720
Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
Accepted for publication May 3, 2014
and 1 case had a working diagnosis of malignant fibrohistiocytic neoplasm. In adults, the lesion is typically poorly circumscribed with a tissue culture-like fibroblastic spindle cell proliferation and admixed ganglion-like myofibroblasts. In adults, necrosis and acute inflammation are uncommon.3 Mitotic figures may be numerous, in both adult and pediatric cases, but are never atypical.4 Cases in children can cause diagnostic difficulty, as histopathological features often differ from classic proliferative fasciitis. Pediatric lesions are often well circumscribed, with a more solid growth pattern and may have acute inflammation and necrosis.3
Pediatric proliferative fasciitis We present three cases of pediatric proliferative fasciitis diagnosed over a 15-year period in a busy tertiary hospital and discuss the histopathological features and differential diagnosis. Materials and methods The institutional files and consultation files were searched for the diagnosis of proliferative fasciitis. For inclusion, the cases had to occur in patients
